Expert Q&A

Bone density: Can it be improved?

What can I do to improve my bone density?

First, it is helpful to remember that bones aren’t just dead structures that hold the body up. They are living tissues that actively respond to the demands placed on them. They are constantly being broken down and rebuilt. As we get older, this breaking-down process can outpace the building-up process. We need to tell the body “Hey, I’m still using this stuff, so don’t get rid of it!” We do this in a few ways: through our diet, our hormones, and our activity.

A healthy diet helps improve bone density

Eating well should be a lifelong project. This means taking in enough calories to support activity (but not so many that excessive body fat is deposited), along with important nutrients such as calcium, magnesium and vitamin D. Ideally, good nutrition should come from your food, not supplements. However, as women age, they might consider a combination supplement of calcium, magnesium and vitamin D to augment a healthy diet. Moderate consumption of soy products may also be beneficial, (although some evidence suggests that women with thyroid conditions should avoid soy). Under-nourishment and a lower-than-healthy bodyweight may be detrimental over the long term. For maintaining bone density, it’s better to be a little bit (but not a lot) heavier than too light.

The balance of "female" hormones affects bone density

Estrogens and progestins, so-called “female” hormones, are a factor in maintaining bone density for both men and women (yes, men have small amounts of “female hormones,” just like women have small amounts of “male” androgens). However, recent results from large-scale studies suggest that hormone replacement therapy (HRT) in menopausal women can increase the risk of health concerns for many people. Thus, HRT is not a one-size-fits all prescription. Researchers are also exploring the possibility of prescribing low doses of androgens to women in later life, as these hormones play an important role.

Exercise can improve your bone density

This brings us to activity. Bones are designed to be loaded by either impact or weight. For example, the femur is designed to absorb and respond to the stresses of moving your pelvis around, to downward loading along its length (for example, when squatting with weight), as well as impact traveling upwards through the leg when you take a step or a jump. This means that staying active, and including impact and weight-bearing movements is critical. Weight training is obviously weight bearing, but also consider activities such as boxing or basketball. In the first case, there is impact loading on the upper body and the lower body when doing the obligatory rope jumping that is part of a boxer’s workout (and recreational boxers need hit only pads and bags, not people). In the second case, there is impact loading from running and jumping. Impact should be moderate, of course – jumping off rooftops will be detrimental to your bone health!

Is is ever too late to improve your bone density?

If bone loss has already begun, your doctor may suggest drugs that help slow the process, but this should occur under the guidance of a medical professional. Drugs alone contribute only a small part – remember that the bones need a reason to stay strong.

It’s never too early to think about bone density. Women build peak bone mass in their late teens and through their twenties. It’s also never too late—even older women who begin a weight training program show improvements in bone density as well as other things like balance and strength, which help prevent the kind of falls that break bones.


Khosla, Sundeep, L. Joseph Melton, III, Elizabeth J. Atkinson and W. M. O’Fallon. “Relationship of Serum Sex Steroid Levels to Longitudinal Changes in Bone Density in Young Versus Elderly Men”. The Journal of Clinical Endocrinology & Metabolism 86 (8): 3555-3561 (2001).

Palomba, Stefano, Francesco Orio, Jr., et al. “Effect of Estrogen Replacement Plus Low-Dose Alendronate Treatment on Bone Density in Surgically Postmenopausal Women with Osteoporosis”. The Journal of Clinical Endocrinology & Metabolism 87 (4): 1502-1508 (2002).

Thomas T, B. Burguera, et al. “Role of serum leptin, insulin, and estrogen levels as potential mediators of the relationship between fat mass and bone mineral density in men versus women”. Bone 29 (2): 114-120 (August 2001).

Krista Scott-Dixon, PhD
Contributing Expert

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